U.S. patent application number 11/983259 was filed with the patent office on 2008-05-22 for bandaging structure and methodology.
This patent application is currently assigned to MJD Innovations, L.L.C.. Invention is credited to Gerhard Paasche.
Application Number | 20080119774 11/983259 |
Document ID | / |
Family ID | 39417804 |
Filed Date | 2008-05-22 |
United States Patent
Application |
20080119774 |
Kind Code |
A1 |
Paasche; Gerhard |
May 22, 2008 |
Bandaging structure and methodology
Abstract
Wound bandaging/dressing foam structure including a low rebound,
temperature-conforming, acceleration-rate-sensitive cushioning
expanse applicable to wound-proximate-associated anatomical tissue
to apply a predetermined expanse of substantially uniform,
non-blood-flow-occluding pressure, accompanied by adjacent,
included lateral extremities of this expanse which apply a
gradually declining-to-zero anatomical-tissue pressure.
Inventors: |
Paasche; Gerhard;
(Scappoose, OR) |
Correspondence
Address: |
ROBERT D. VARITZ, P.C.
4915 SE 33RD PLACE
PORTLAND
OR
97202
US
|
Assignee: |
MJD Innovations, L.L.C.
|
Family ID: |
39417804 |
Appl. No.: |
11/983259 |
Filed: |
November 7, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60859770 |
Nov 16, 2006 |
|
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|
Current U.S.
Class: |
602/53 |
Current CPC
Class: |
A61F 13/00021 20130101;
A61F 2013/0074 20130101; A61F 2013/0028 20130101; A61F 13/069
20130101; A61F 2013/00187 20130101 |
Class at
Publication: |
602/53 |
International
Class: |
A61F 13/00 20060101
A61F013/00 |
Claims
1. Wound bandaging/dressing foam structure including a low rebound,
temperature-conforming, acceleration-rate-sensitive cushioning
expanse applicable to wound-proximate-associated anatomical tissue
to apply a predetermined expanse of substantially uniform,
non-blood-flow-occluding pressure, accompanied by adjacent,
included lateral extremities of this expanse which apply a
gradually declining-to-zero anatomical-tissue pressure.
2. The structure of claim 1, wherein the cushioning expanse
includes a central body of one relatively uniform thickness having
lateral-edge wane regions tapering from such relatively uniform
expanse thickness to zero thickness.
3. The structure of claim 2 which further includes a generally
shape-defining, relatively rigid shell supporting an outer side of
the foam structure.
4. The structure of claim 1 which further includes a generally
shape-defining, relatively rigid shell supporting an outer side of
the foam structure.
5. A wound bandaging/dressing foam structure including a low
rebound, temperature-conforming, acceleration-rate-sensitive
cushioning expanse organized in a shell to envelop a wound in an
envelopable anatomical extremity.
6. The structure of claim 5 which includes a pressurization
mechanism therein, having bladders located between said cushioning
expanse and said shell.
7. The structure of claim 5 which includes a cooling mechanism
therefore, wherein the cooling mechanism includes cooling vessels
extending throughout said shell.
8. The structure of claim 5 wherein said shell is in the form of a
clam shell.
9. The structure of claim 5 wherein said shell extends the full
length of an extremity.
10. The structure of claim 5 wherein said shell extends less than
the full length of an extremity.
Description
RELATED APPLICATIONS
[0001] This patent application claims priority from U.S.
Provisional Patent Application Ser. No. 60/859,770, for Bandaging
Structure and Methodology, filed Nov. 16, 2006, which describes
improvements and variations to the subject matter disclosed,
illustrated and claimed in U.S. Pat. No. 6,812,375 B2, granted Nov.
2, 2004, for Pressure-evenizing Low-rebound Wound Dressing, the
contents of the provisional patent application and the patent are
incorporated herein by reference.
FIELD OF THE INVENTION
[0002] This invention relates to medical dressing for wounds, and
specifically to a medical dressing which provides evenly
distributed pressure about a wound site.
BACKGROUND OF THE INVENTION
[0003] A background description of the prior art is found in U.S.
Pat. No. 6,812,375 B2. This application describes further
improvements and modifications to the subject matter of the '375
patent. One improvement is the incorporation into an otherwise
generally uniform-thickness, pressure-evenizing foam structure of
surrounding, lateral wane regions, which diminish in thickness to
zero. These wane regions create a "downward" wound-area-applied
pressure gradient adjacent lateral regions of a wound, with
appropriate use of a dressing formed in accordance with the
invention.
[0004] Two other improvements include (a) the utilization of a
relatively rigid shape-holding, and generally
bandaging-three-dimensional shape-defining, shell which is fitted
with pressure-applying foam in accordance with the invention, and
(b), a clamshell-type arrangement in which a clamshell style,
generally rigid shell structure holds a pair of pressure-applying
foam structures to enable complete wrap-around, or substantially
full-enclosure, dressing of a wound which exists in an extremity,
such as in a hand or a foot.
[0005] By way of additional background, the conventional way of
post operational bandaging, for example, in the case of a knee
replacement, requires, after stapling the skin together as the
final step of the operation, application of a sterile fleece, which
serves for the collection of blood coming out of the wound.
Additional cloth padding that is intended to add pressure to the
operated area to compress the tissue, to suppress internal
bleeding, and to suppress formation of cavities that may fill with
blood and other body fluids, is placed on top of the sterile
fleece. As the final step, a five inch wide elastic bandaging is
wrapped in a spiral around the leg, beginning at foot, with
overlapping, and terminating at the top of the thigh.
[0006] Uneven pressure distribution and local stagnation lead to
the suppression of flow in the venous and lymphatic systems,
increasing the risk of thrombosis and other problems related to
circulation. These are evidenced by visible pressure lines, which
may be observed with removal of the elastic bandage.
[0007] Occasionally, especially with post-operative restless
patients, the bandage may be displaced, and may, on occasion,
become totally unwrapped, which requires that the elastic bandage
be repositioned, with further implied complications. This is
inconvenient, especially as the time-consuming bandaging
unnecessarily occupies nursing personnel, preventing their
attention to other duties.
[0008] If the bandaging is not carefully applied, the likelihood of
ulcers forming e.g., on the heel, may increase, which adds further
complications, such as extended heeling time and complicated
patient rehabilitation.
[0009] Immediately after the operation, continuous passive motion
(CPM) is used with a guide apparatus. Conventional bandaging
results in pinching of the bandaging on the back of the knee,
resulting in generally vocal complaints from the patients, thus
limiting willing patient cooperation.
SUMMARY OF THE INVENTION
[0010] Wound bandaging/dressing foam structure including a low
rebound, temperature-conforming, acceleration-rate-sensitive
cushioning expanse applicable to wound-proximate-associated
anatomical tissue to apply a predetermined expanse of substantially
uniform, non-blood-flow-occluding pressure, accompanied by
adjacent, included lateral extremities of this expanse which apply
a gradually declining-to-zero anatomical-tissue pressure.
[0011] It is an object of the invention to provide a bandaging
structure having a generally uniform-thickness, pressure-evenizing
foam structure of surrounding, lateral wane regions which diminish
in thickness to zero.
[0012] Another object of the invention is to provide a relatively
rigid shape-holding, and generally bandaging-three-dimensional
shape-defining, shell which is fitted with pressure-applying
foam.
[0013] Yet another object of the invention is to provide a
clamshell-type arrangement in which a clamshell style, generally
rigid shell structure holds a pair of pressure-applying foam
structures to enable complete wrap-around, or substantially
full-enclosure, dressing of a wound which exists in an extremity,
such as in a hand or a foot.
[0014] This summary and objectives of the invention are provided to
enable quick comprehension of the nature of the invention. A more
thorough understanding of the invention may be obtained by
reference to the following detailed description of the preferred
embodiment of the invention in connection with the drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] FIG. 1 is a perspective representation of a first embodiment
of a pressure pad of the invention.
[0016] FIG. 2 is a cross-section of the pressure pad of FIG. 1.
[0017] FIG. 3 is a perspective representation of a second
embodiment of the pressure pad of the invention.
[0018] FIG. 4 is a cross-section of the pressure pad of FIG. 3.
[0019] FIG. 5 is a section through a wound site with a pressure pad
of the invention applied thereto.
[0020] FIG. 6 depicts a pressure pad of the invention as used for
applying pressure to an appendage.
[0021] FIG. 7 depicts a tourniquet application of the pressure pad
of the invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0022] Referring now to FIGS. 1 and 2, a first embodiment of the
pressure pad structure of the invention is depicted generally at
10. As noted in the above-identified patent, pressure pad structure
10 is formed of a material known as Confor, which is made by EAR
Specialty Composites of Indianapolis, Ind. The specific material,
in the preferred embodiment, is Confor CF-40, although other Confor
materials may be used, with the other materials having durometer
ratings different than CF-40. The material used in pad 10 is a
compressible, low rebound, acceleration-rate-sensitive material
which, after a compression deformation, exhibits a slow creep
return toward an undeformed condition. Any foam material exhibiting
the foregoing characteristics may be used as the visco-elastic foam
material in the practice of the invention or of the method of the
invention. Pad 10 includes a lower surface 12, which is directed
towards the patient in use, an upper surface 14, and a peripheral
expanse, which tapers from upper surface 12 to lower surface 14 in
a wane region 16.
[0023] Joined to that face of the lower surface is a thin layer 18,
typically about 0.003- to about 0.01-index, of a suitable
moisture-barrier material which is made herein of a sprayed-on
layer formed of a vinyl-solvent-based material known as Russell
Coating, sold under the product designator V-2000, and manufactured
by Russell Products Company, Inc., of Akron, Ohio. In the
embodiment of the invention now being described, it is the exposed
facial expanse specifically of moisture-barrier layer 18 which
substantially directly engages, in most instances, the surface area
of the wound area to which bandaging pressure is applied by device
10. As will become evident after reading the entire Specification
hereof, moisture-barrier layer 18 may be fixed to pad 10, or may be
applied directly to a patient, or over a fleece absorbance layer,
thus, pad 10 may be formed with or without integral
moisture-barrier layer 18.
[0024] Thus, pad 10 provides a wound bandaging/dressing foam
structure having a low rebound, temperature-conforming,
acceleration-rate-sensitive cushioning expanse applicable to
wound-proximate-associated anatomical tissue to apply a
predetermined expanse of substantially uniform,
non-blood-flow-occluding pressure, accompanied by adjacent,
included lateral extremities of this expanse which apply a
gradually declining-to-zero anatomical-tissue pressure. The
cushioning expanse includes a central body of one relatively
uniform thickness having lateral-edge wane regions tapering from
such relatively uniform expanse thickness to zero thickness.
[0025] The width, height and length of pressure pad structure are
all variable. Base shapes can be triangle circular or any odd
shape. The beveling of the edges creates a pressure transition area
and with that, avoids pressure lines at the edges of the pressure
pad. It also allows for overlapping of pieces to branch out, as
applicable in a phlebectomy. It has been shown that when stripping
out the veins during a phlebectomy, blood pooling and blisters
usually associated with this operation can be almost totally
prevented. This naturally leads to a very short healing time and
also to fewer complications, and is thus specifically well suited
for use in such a procedure.
[0026] The cure of decubitus ulcers (bedsores) is another
application which warrants special attention, as it has to do with
a careful balance of pressures around the wound areas. The need to
apply a local pressure that restricts blood and lymph flow
laterally (sideways) in the surface areas towards the wound, and
may allow the body to feed in the needed support for building new
tissue vertically from below. Referring now to FIGS. 3 and 4, an
embodiment of the pressure pad structure of the invention is
depicted generally at 20, which structure is useful to speed
recovery of ulcers. Pad 20 is formed much like pad 10, having an a
lower surface 22, which is directed towards the patient in use, an
upper surface 24, and a peripheral expanse, which tapers from upper
surface 22 to lower surface 24 in wane expanse region 26. A layer
of a suitable moisture-barrier material 28 is formed on lower
surface 24.
[0027] Pressure pad 20 may be placed around an ulcer, and when held
in place by an elastic bandage, the foam material will reduce the
blood pressure in the surrounding tissue, thus allowing for the
healing of the ulcer. The same technique may be applied to ulcers
in the area of the head, by using a rounded shell, similar to a
helmet, which is padded on the inside with the visco elastic foam.
This distributes the weight of the head to different areas and
allow healing of the ulcer. In addition, it is relatively
comfortable, resulting in acceptance by patients. This helmet kind
of a device may be made of a simple vacuum molded shell which is
strapped to the head of the patient, or if preferred, is integrated
into a "pillow style" cushion. As there is generally little
movement associated with the presence of ulcers, ventilation must
be provided to the areas around the wound, which ventilation may be
provided by varying the shape and size of the ring. Beveling is
important to the outside to have a smooth transition to the
pressure zone, e.g., parallel surface area.
[0028] Referring now to FIG. 5, pressure pad 10 is depicted in
situ, as applied to an extremity 30. The region of the anatomy
which is bandaged by pressure pad 10 is generally shown at 30, and
is here pictured with a quite uneven, undulating topography.
Specifically also illustrated in FIG. 5, and underlying the surface
of this anatomical site as is indicated by a cross (+) is a
pulsatile blood-flow artery or vein. This region of the anatomy is
especially distortedly emphasized in FIG. 5, in order aid in
explaining and visualizing an important behavioral operation of the
invention. An exaggerated BULGE is shown and so labeled in FIG.
5.
[0029] In dashed lines in FIG. 5, this particular area of site 30
in the anatomy is shown distended, or bulged, upwardly to follow a
line which is pictured by various styles of dashed lines. This
region, under such a circumstance, is clearly not a candidate for
the conventional application of overly high pressure in a normal
bandaging arrangement.
[0030] Uniquely, and because of the acceleration-rate-sensitive
nature of pad 10, when it is appropriately placed to apply pressure
to wound area 32, the skin-facing surface region of pad 10 and
layer 18 adjusts its topographical characteristics so as to
produce, ideally, a substantially matching complementary
topography--and very specifically a matching topography which tends
to produce a generally evenized pressure over the entirety of site
32.
[0031] Thus, from a purely static pressure-applying point of view,
the portion of device 10 which acts through surface 12 and layer
18, directly over wound site 32 tends to adjust so as to apply
appropriate topographically-following, relatively even pressure
such that undesirable overpressure and underpressure conditions
mentioned above do not come into play.
[0032] From a dynamic point of view, and in response to pulsatile
behavior as pictured in FIG. 5, the acceleration-rate-sensitive
material in pad 10 tends to respond to increased bulging, as a
consequence of periodic blood flow, to yield, and when bulging
begins to recede, to follow that receding activity with little or
no appreciable spring-rate behavior. A consequence of this is that,
even in a dynamic pulsatile region in a bandaging site, the pad of
this invention tends to adapt appropriately and easily to changing
topographic conditions, and specifically in a manner tending to
maintain substantially even overall bandaging pressure. The
moisture-barrier layer 18 prevents the invasion of any weeping
fluid near the wound site into pad 10.
[0033] In practice, following knee-joint replacement, the complete
leg, including the foot, was wrapped in foam and kept it in place
with elastic band wrapping as normally used for bandaging, to apply
pressure after the operation. As a result of the use of the pad and
method of the invention, the leg and foot looked well two-days
after the operation when the bandaging was removed.
[0034] It will be understood by one of ordinary skill in the art
that the moisture-barrier layer integrally formed with the pad
prevents the dissipation of moisture from the wound, whether such
moisture is the result of perspiration or seepage from the wound.
Regardless of the source, moisture needs to be removed from the
vicinity of the wound. As a difference to the usual practice of
just using a layer of gauze to collect the bleeding out of the
wound during the first days after the operation, a layer of a
sterile cellophane-like membrane was placed on top of the wound
area to avoid any contamination which might come from the foam.
This is essentially moving the moisture-barrier layer from the foam
to the leg as a self-adhesive layer. Another alternative for
solving the problem of moisture transport away from the tissue
under the moisture-barrier layer is to use a sweat wicking fabric
to enhance the wicking of sweat that gets transpired by the
skin.
[0035] Referring now to FIG. 6, the foam material used for pressure
pads 10 and 20 is encapsulated in a shell enclosure 40 that is
essentially a two-sided shell style enclosure having a top side 42,
a bottom side 44, which sides are held together by a hinge 46, and
which further has an opening 48 on the non-hinged side which allows
a foot or hand to be transitioning to the inside providing even
pressure to the foot/hand after an operation with preformed foam
inserts 50, 52, which may have a moisture-barrier layer or not. The
foam inserts may be replaced when the shell is next used. Easy
access for control after the operation and during the healing
process is provided through hook and loop fasteners (not
shown).
[0036] Referring to FIG. 7, a portion of another embodiment of the
invention is depicted generally at 54, and is similar to a
pneumatic tourniquet, or blood pressure measuring bladder, except
that it is sized to surround or cover a complete extremity, forming
a sleeve thereover, and includes multi-part chambers, which take
the form of a series of rings extending about the interior of a
banding structure, or which may extend at various angles from the
banding structure. A shell 56, formed in sections, extends the
length of the sleeve 54. Shell 56 may be formed of a rigid or
semi-rigid material. Alternately, a flexible material may be used
so long as such material has an unyielding outer skin, so that
pressure may be applied to the desired location.
[0037] This sock or bladder style configuration, which is strapped
around the extremity or body part, and held in place by
hook-and-loop fasteners 58, has an integrated array of air chambers
60, part of a pressurization mechanism, on the inside thereof,
which applies pressure to foam 62 to achieve even distribution and
breathing activity. A cooling mechanism is provided and includes
vessels 64 which allow a coolant to circulate throughout sleeve 54,
is located between the foam and the bladder (air chambers), which
allows flexibility for exercising and, if needed, may be opened and
closed at any time for inspection. While bladder tourniquets are
known, none have the visco-elastic foam described herein generating
the transitional evenizing pressure of the invention. A pressure
control 66 is provided which adjusts the pressure depending on the
orientation of the patient, to compensation for blood pressure
variations, and to provide application of pressure to control a
swelling of e.g., a leg, which orientation, and other parameters,
is detected by a sensor array 68, which comprise the remainder of
the pressurization mechanism. The continuous pressure control
automatically adjusts as the swelling becomes less, while the
visco-elastic foam maintains constant pressure. Other features of
such an active system allow application of pressure curve profiles,
together with temperature profile curves, for therapeutic reasons
and to allow to release of some pressure for a limited amount of
time, or as well allowing the patient to adjust pressure to a
comfortable level, while not dropping below a predetermined minimum
set by the attending physician. As the foam layer is
interchangeable, foams of various durometer ratings may be used for
different applications, pressure ranges and temperature ranges.
Experience has shown that the distal end of the extremity should be
exposed to the same amount of outside pressure as is the proximal
end, otherwise any unpressurized areas on the distal side of the
bandaging is likely to swell, which likely will lead to additional
complications.
[0038] The foam attached to the inside of variously formed shells,
that may be either fairly rigid or flexible, depending on the
position of the application as well as the complexity of the
underlying shape that needs to be covered. Variations in the foam
durometer may be used to detect especially sensitive areas and to
control the amount of pressure. The shell shapes may be as simple
as a flat piece of plastic bent into a channel form up to fairly
complicated shapes that may be either vacuum formed plastics or
other preshaped formed materials with surfaces that have the foam
applied to the inside.
[0039] In actual patient applications, the complete leg, including
the foot, was wrapped in foam, kept in place with an elastic band
wrapping, as normally used for bandaging, to apply pressure after
the operation. As a result, the leg and foot looked well after the
operation when the bandaging was removed two days after the
operation. As a difference to the usual practice of just using a
layer of gauze to collect the bleeding out of the wound during the
first days after the operation, a layer of a sterile
cellophane-like membrane was applied to the top of the area to
avoid contamination which might originate in the foam. This is
essentially moving the coating from the foam to the leg as a self
adhesive layer that is available and also sterile.
EXAMPLE 1
[0040] A knee replacement operation was performed on a patient.
Such an operation is a severe intrusion into the body, in which the
complete knee joint is replaced by an artificial joint. The access
cut that is needed to perform this surgery is about 10 inches long.
There is a significant amount of tissue separation involved in this
operation as well as other traumatic events taking place at the
same time, e.g., to the circulatory system. Fleece was applied to
the wound, which was covered by a pressure pad of the invention,
and the leg wrapped with an elastic bandage. After two days, a
comparison of a patient who was bandaged using conventional
techniques was compared to the patient bandaged using the pressure
pad structure and methodology of the invention. The evaluation by
the attending physician, who had performed the operations, was that
there were significant differences between the two patients: (1)
when opening the bandaging with the added foam two days after the
operation, there was significantly less contamination of blood in
the fleece on the wound compared to the conventionally bandaged
patient; (2) the appearance of the skin and overall appearance of
the leg tissue of the patient bandaged using the pressure pad and
method of the invention was very healthy; and (3) overall swelling
of the leg was less.
[0041] The second patient, having received conventional bandaging
applied after the operation, had significant signs of suppression
of circulation to the surface of the skin, a common cause of
additional complications, there was also more bleeding into the
fleece, which had come out of the actual surgical cut. Overall, the
conventionally bandaged patient exhibited indications that the
applied pressure after the operation was not as uniform as in the
other patient.
EXAMPLE 2
[0042] A phlebectomy procedure, the removal of varicose veins, was
treated post-operatively using the pressure pad and method of the
invention. A sterile fleece provided a catch for blood coming out
of the wound. A sterile, self-adhesive foil was applied to fix the
fleece in place. A cotton sock, as commonly used with a
plaster-cast, was used to cover the leg top-to-bottom as a
separation layer under the foam. Then the foam was applied over the
affected area of the leg and elastic bandaging applied on top of
the foam to provide the needed pressure.
[0043] The comfort for the patient was very good. The pressure pad
and method of the invention proved to be very useful, especially
when using the CPM system, which is a critical part of
rehabilitation following joint replacement, to allow for exercising
the joint without muscle flexion/extension by the patient. The
compression of the wounded area as well as the rest of the leg was
very good. The tissue texture (appearance) for the areas covered
with the foam was excellent and indicated that there were no
complications to be expected, as might usually appear. The forming
of ulcers using the pressure pad and method of the invention is
virtually impossible. This is an important consideration,
especially for older patients who may have very thin and sensitive
skin.
[0044] Thus, a pressure pad structure and method of use for
post-operative wound dressing has been disclosed. It will be
appreciated that further variations and modifications thereof may
be made within the scope of the invention as defined in the
appended claims.
* * * * *